Pediatric considerations for proton therapy

Delivery of re‐irradiation and complex palliative radiotherapy using proton therapy in pediatric cancer patients

“…Protons are typically applied to curative-intent treatment in the pediatric population, where its value is placed on the reduction of late effects in long-term cancer survivors. 6 In a 2016 consensus report from the Stockholm Pediatric Proton Therapy Conference, the group felt that the best proton candidate was a child with a curable tumor requiring focal treatment. 7 Palliation, however, does not always denote poor prognosis or end-of-life care, and there are scenarios in which a child may live for many years with a non-curable cancer.…”

“…5 This, coupled with the substantial cost and relative scarcity of proton facilities, has likely led to the reservation of proton RT for curative-intent treatment. 2,6 Indeed, the use of protons in the setting of palliative RT is rare: with one survey reporting that protons were employed in just 1% of 427 RT courses, and specifically reserved for treatment of the brain. 3 At our tertiary referral center, children are increasingly receiving palliative-intent proton radiation therapy (PIPRT) for additional, selected indications.…”

“…Protons are also advantageous in the pediatric population given developing tissues are more prone to developmental toxicity, and young patients have a lifetime potential to develop late toxicity and radiation‐induced malignancies 5 . This, coupled with the substantial cost and relative scarcity of proton facilities, has likely led to the reservation of proton RT for curative‐intent treatment 2,6 . Indeed, the use of protons in the setting of palliative RT is rare: with one survey reporting that protons were employed in just 1% of 427 RT courses, and specifically reserved for treatment of the brain 3 .…”

“…The median PIPRT reRT dose was 3600 cGy (range: 1980-6250), and the median number of reRT fractions was 17 (range: 8-33). There were three who received adjacent reRT (patients 3, 15, 18) and 12 direct reRT (patients1,2,5,6,7,9,11,12,13,14,16,17). Further details of targets of PIPRT and prior radiation courses are summarized in Table1.…”